The primary objective of this mentored K23 award is to acquire the necessary skills in clinical research that are needed to become an independent investigator in Pediatric Rheumatology, a critically underserved area. The local environment for clinical and laboratory research in pediatric systemic lupus erythematosus (SLE) is outstanding, and includes highly accomplished mentors with established, interactive research programs. The scientific aims of this proposal are intended to further Dr. Sule's ultimate career goal: to improve the care and clincal outcomes for pediatric patients with SLE. Working closely with her mentors as well as clinical and laboratory collaborators,Dr. Sule will establish a pediatric SLE cohort (SA 1). She will define predictors of disease activity (SA 2) and disease damage (SA 3) in pediatric patients with SLE. She will then compare these predictors to the already established and well-defined adult SLE cohort at Johns Hopkins. We expect that there will be differences in clinical and laboratory values between these two groups. For example, in pediatric patients, changes in laboratory values (such as decreased albumin and complement levels, or increased dsDNA) may only occur prior to disease flares. This pattern may not be observed in adult patients. These comparisons in identically established, prospective adult and pediatric cohorts will provide significant insights, and, to our knowledge, have never been performed. Even if no differences are observed, the establishment of the prospective pediatric SLE cohort is important as it will elucidate the natural history of pediatric SLE in the current treatment era. The establishment of this cohort will allow identification of targets for future interventions to improve outcomes in these patients. Studies in established adult SLE cohorts have accomplished this goal. We expect that the pediatric cohort that Dr. Sule will establish during the K23 award will bejust as valuable in pediatric SLE and will be an outstanding vehicle for future independent clinical research in Pediatric Rheumatology. Lay Language: The goal in Pediatric Rheumatology is to prevent activity and damage from autoimmune diseases that we cannot yet "cure" so that children can lead healthy lives. In order to do this, we need to define predictors of disease activity so that we can intervene with treatments that minimize disease damage. We propose to establish a pediatric SLE cohort, which will lead to a better understanding of pediatric lupus and make a difference in these childrens1 lives.